Most moms who wanted to breastfeed, but ended up formula feeding, will be able to cite a reason or two. Breastfeeding advocates generally say that most of those hurdles can be overcome most of the time. The divide between these two perspectives -- of insurmountable versus surmountable problems -- often results in heated discussions and hurt feelings. Moms feel like they are being told that they didn't try hard enough and breastfeeding advocates are frustrated at the lack of recognition of other contributing factors.

In Canada, around 90% of women initiate breastfeeding, which is great. But things go downhill quickly. The World Health Organization and Health Canada both recommend six months of exclusive breastfeeding, with continued breastfeeding until 2 years or longer. How do the Canadian statistics stack up against that recommendation? At 3 months, 68% of moms are breastfeeding and 51% are exclusively breastfeeding. At 6 months, 54% are breastfeeding and 14% are exclusively breastfeeding.

Or, in other words, by the time a baby is 6 months old:

10% will have never been breastfed

36% will have been weaned

40% will have been supplemented at some point (either with formula or early introduction of solids, other milks, juice, etc)

14% will have met the recommended duration of exclusive breastfeeding

Why are so few moms meeting the recommended duration of exclusive breastfeeding?

Reported Reasons

According to a Today's Parent Survey (by John Hoffman), only 1 in 10 women report "problem-free" breastfeeding. That means that 90% of women who chose to breastfeed have to overcome some sort of hurdle in order to continue breastfeeding. Some of the are able to overcome those hurdles with help or with time. But others are not.

According to the Today's Parent Survey, three types of breastfeeding problems were particularly prevalent among moms who weaned early:

Low milk supply

Low baby weight gain

Baby who seemed uninterested in nursing or nursed inefficiently

Some other reasons I've frequently heard moms moms give for supplementing prior to six months include:

Wanting or needing to leave baby temporarily (work, date night, weekend away) and not wanting to pump or not being able to pump enough.

Doctor or parenting book advised them to introduce solids before 6 months.

Contributing Factors

The reasons that moms give for stopping breastfeeding are an outcome -- low milk supply, low baby weight gain. There need to be reasons for those outcomes. In a small percentage of women, there are legitimate insurmountable medical reasons for those outcomes. However, for most mothers, it is other contributing factors (likely in combination with difficult but surmountable breastfeeding challenges) that can lead to that result.

Not enough breastfeeding support (not having access to support when you need it or not being able to afford quality support)

Poor quality breastfeeding support (getting bad or inconsistent advice, which can lead to more problems instead of resolving the problems, was about twice as prevalent among moms who stopped early than those who continued breastfeeding)

Twice as likely, 3.5 times as likely, twice as prevalent, much more likely, four times as likely, and so on -- it all adds up.

Moms don't usually name a formula sample, a not-so-knowledgeable doctor, or a lack of comfort nursing in public as the reason for their low milk supply, but in a lot of cases it probably is a contributing factor. That doesn't mean that these moms didn't try hard enough (and really, hard enough is subjective and will be different for each person), but it does mean that these are issues worth tackling. They are hurdles, or barriers or booby traps, or whatever you want to call them. They are silent killers of breastfeeding relationships.

What is Missing?

We can compare the statistics on actual breastfeeding duration with the recommended duration and see that Canadian mothers come up short. But that doesn't tell the whole story. The key information that is missing from these statistics is information on women's breastfeeding goals. We need a long-term study that asks pregnant women how long they plan to breastfeed exclusively and when they plan to wean and that compares that with what actually happens. Is there a gap? If so, how big is it? What reasons do the moms give for the gap? What other contributing factors came into play? A comparison between the recommended duration of breastfeeding (6 months exclusive, continued nursing for 2 years or more), women's own breastfeeding goals, and actual length of breastfeeding is essential to a full understanding of where and how things break down.

More Data, But What Else?

Yes, we need more data. That said, there is already some evidence that a lot of women stop breastfeeding earlier than they planned to. According to the Today's Parent survey, at least 1/3 of breastfeeding moms stopped earlier than they had planned and the numbers are probably higher for first time moms.

In the meantime, however, we need to keep working on breaking down the barriers and tackling those contributing factors. They should be eradicated wherever possible. Or, where that isn't (yet) possible, we need to at least make moms aware of the danger so that they can protect themselves and their breastfeeding relationship.

Breastfeeding advocacy doesn't really need to focus on the 10% of women who choose not to breastfeed. It needs to focus on the large numbers of women want to breastfeed and are devastated when things don't go the way they wanted them to. Breastfeeding advocates need to create awareness among those women (before it is too late) and help them to navigate the minefield.

What do you think should be the first priority in tackling those contributing factors?

Reader Comments (118)

I am actually breastfeeding longer then I thought. I am at 14 months now. I exclusively breastfed until about 8 months. My little one wasn't interested in food. We did baby led weaning. She only took to food around 10-11 months maybe.

The first month or so of nursing I wanted to quit everyday, it was painful and there were lots of tears, but I persisted and got support and made it through. I am so happy I did! :)

I have some breastfeeding question: can I get in touch with you Annie? I would love your opinion if you have the time! :)

I wish the partial category was split. It would be interesting to see how many people start food early; how many supplemented initially and then moved to exclusive breastfeeding; and how many started by exclusive breastfeeding and moved to supplementing. For instance, I would be listed as partial because my baby got formula in the NICU until I could pump enough to cover my baby's meals (4 days). I got the best breastfeeding support possible and have exclusively pumped/breastfed since then so I think I am a different situation to someone who had a fussy baby at the breast and started supplementing with formula due to this.

As for priorities - the doctors have to be number one. So many doctors are misinformed as to current breastfeeding practices and are just plain breastfeeding-unfriendly. If we can get doctors (all docs not just pediatricians!) on board to support women and their breastfeeding goals (whatever those goals might be!) we'd be half way there.

Great post! I appreciate that you don't cut on women who choose not to Breastfeed. Baby c was breastfed for 3 weeks, but in that time she wasn't gaining weight and I needed to supplement. At 3 weeks I was in the hospital for an e.coli infection and she with spinal meningitis. We had to give up Breastfeeding all together.

I think the first step should be to require all hospitals with maternity servcies to be Baby Friendly Hospitals. This would help ensure that women were having a good start to their breastfeeding relationship, with accurate information and adequate early support to stave off those common, early-weeks difficulties.

Then, I'd say we need better community-based lactation support networks- just as women discuss what daycare they'll send their child to (if they do not stay home), we should have the names of professional lactation guides and peer counseling support groups at the tips of our fingers. It should be as common to have a lactation guide & support group as it is to have a pediatrictan & a babyshower.

Finally, I think there should be strict, regulated marketing guidelines for formula. No print ads in parenting magazines, women should have to opt in for formula samples (instead of having them sent simply because they shopped at a certain store), etc...

These three steps would protect breastfeeding for those women who choose to do so...

Interesting data. I think doctors need to be more educated. At my son's 2 week checkup the doctor told us to start supplementing with a bottle of formula each day "just so he gets used to it in case you want to go on a date or something". I was disgusted by the suggestion, am am still nursing him as a two year old. But I bet a lot of people would think that was sensible advice!

I agree with Joyce, I think having better data for the "partial" category would help. I'd also love to see continued research on the effects of IV fluids given to Moms during birth and subsequent breastfeeding challenges. With my son, we were more or less forced to supplement while in the hospital (Don't even get me started on that, four years later it STILL makes me angry) and for his first month (because the pediatrician insisted, until after a month when I got up the courage to throw the SNS and formula away and EBF from then on) - and I am absolutely 100% convinced that many of our breastfeeding and DS' weight loss problems were directly related to the massive amounts of IV fluids I received during labor & delivery (5 liters. Yes, FIVE.) I cannot be the only one in this situation, given the prevalence of IV fluid use during hospital births, particularly when epidural anesthesia is used. So I think that really, truly understanding and continuing to study the effects of that on breastfeeding initiation and duration could make a huge difference. If we know that baby loses a bit more weight after birth when Mom had a huge fluid bolus then maybe pediatricians would be less likely to push formula so hard until it was clear that bab's weight loss was not just due to loss from excess fluid

But I think the lack of seeing breastfeeding in our society is probably the biggest deterrent. I can count on one hand the number of times I saw a baby nursing before I had my own. Women go into it with no prior knowledge of what its going to be like, how often the baby will need to be fed, what kind of problems they might have, and then add to all that the uncomfortable feeling you get every time you need to feed the baby in front of other people makes it so much worse. I'd love to see nursing on TV in every show or movie with a baby, and not as some bizarre joke (like accidentally drinking pumped milk), but just to replace every seen where they show a baby with a bottle or making a bottle with the mother nursing would be beneficial.

I am still breast feeding my son who is now 19 months. My child will stop when he's ready. Breast feeding was physically difficult at first. No one tells you how incredibly painful it can be. Then when your breasts finally get used to it, after a month or two, their her usually has to go back to work. In my case I quit working because I had to be completely available 100 percent to my baby. Many women think they can do both and try to pump and it becomes a huge chore. Women are being misled to think that they can do it all. The experience of motherhood with breast feeding has changed me radically. To breast feeding a mother has to be completely available to her child, she has to be flexible and she has to put her child first. Many women I know are simply to rigid to breast feed and they want to resume living the way they were prepregnancy. The women who can let go of their old selves, and are flexible and open enough to try something new, to live differently, will be able to breast feed successfully their child for a long time. The child knows what is best for him and can lead the mother to do the right thing.

I always wonder about the "partial breastfeeding at 6 months" number. I figure there's a difference (at least when looking at breastfeeding advocacy) between a 6 month old who is exclusively breastfeeding expect for a few bites of solid foods, vs one that's getting half breastmilk and half formula. Knowing that split would tell us a lot more.

As for priorities, I think hospitals need to become Baby Friendly so can avoid the booby traps that arise in those first days, and pediatricians NEED to become more educated about breastfeeding. When my 3yo was a breastfeeding baby, we twice hit a stumbling block with breastfeeding. First was when he was 6 months old and our pediatrician, who was VERY pro-breastfeeding and had literally cheered me at every well check for still breastfeeding exclusively, became worried because he'd dropped from 50th% to 25th% for weight. What was the first suggestion from my extremely pro-bfing doctor? "Try formula." (at first we tried, but long story short he refused bottles and we realized he was totally fine & healthy and just skinny, and figured that was his normal weight pattern)

A few months later we'd moved, and were seeing a different pediatrician. He was about 10 months old and for whatever reason, for about a week, my supply just tanked and he started having very few wet diapers. This other pediatrician was also very pro-bfing, but again-- the *first* suggestion was to supplement with formula.

Pediatricians NEED to go through breastfeeding training, or at the very least need to start refering to an IBCLC for breastfeeding help rather than just suggesting formula as the first option.

I agree that I think a big help would be to help women realize that nursing on cue is optimal and to relax about feeding "schedules" etc.

But do please keep in mind that quitting a job and staying home are a luxury that is not available to many women. This is why part of the focus also should be on making workplaces more breastfeeding- and pump-friendly.

Thank you for posting this. It sparked a wonderful conversation with my husband today and another mom. My brain is too frazzled from the two kids today to think of what I really want to say in regards to responding to your actual blog above, but I bet a general thanks is better than nothing! Keep up the great posts!

Hi I am a l and d nurse, I had my heart set on breastfeeding. At four days old my baby had lost 12 percent of his weight I started pumping and supplementing with similac. My milk did not come in until day 7. With ac Pc weights my baby never took more than 40 ccs after eating for 30 min. Now I mostly pump and bottle and give similac. I have never pumped more than 15 oz pumping six times a day. I tried everything under the sun to boost my supply.

I totally agree that doctors need to be better educated on breastfeeding & treat it less like a scheduled drug regimen--scheduled feedings rather than on demand probably affect many moms' milk supply. However, I think training more midwives would go a long way toward improving breastfeeding rates, among other things. My care provider was a group of midwives, who were well trained on (& nearly all had personal experience) breastfeeding. I suspect that breastfeeding stats would look a lot better if more women in Canada saw midwives rather than doctors, not only because of the improved postpartum support, but also because midwives are generally less likely to do unnecessary medical interventions that can negatively impact breastfeeding, like IV fluids, epidurals, c-sections, etc.

I had a lot of difficulty with breastfeeding & despite decent support at the hospital where I delivered (BC Womens', an official baby-friendly hospital), seeing a lactation consultant, going to a doula-led breastfeeding workshop, support from my midwives, public health nurse, & a doctor specializing in breastfeeding issues, I still couldn't exclusively breastfeed. From when baby was two weeks old & he hadn't gained any weight, I was advised to start supplementing with formula (or milk from the BC Women's milk bank, but we only managed to get a few litres in total). I pumped after every feeding, took herbs, drank lactation tea, went on Domperidone, avoided certain foods like mint & sage, ate oatmeal... EVERYTHING that I could do to increase my supply.

After about four months of pumping six times a day & keeping a log of how much formula baby was drinking, etc, etc, etc, I got to the point where baby was getting about 80% breastmilk. The whole process nearly drove me nuts, & I never would have stuck with it had I not had my husband home with me to feed baby his supplement, help with all the bottle washing, etc. (He got laid off a day after going back to work following our son's birth. Because he was able to get EI it was the best thing that could have happened, honestly.)

That's something I'd like to see some investigation on: what do breastfeeding rates look like in countries where *both* parents are able to stay home for at least the first month or two? If women's partners could be home longer than the days or couple of weeks that their employer lets them take, maybe moms could get a little bit more sleep, eat a little better & be able to focus on breastfeeding more than they could on their own.

By the way, we stopped the formula supplements at about 10 months when it seemed baby was getting enough nourishment from solids. Now, at nearly 16 months, he is still breastfeeding. It's something I'm extremely proud of after all we went through to get here. I plan to breastfeed at least until he's two. I'd like to have another child, so depending on how that pregnancy affects breastfeeding, I may wean him, rather than letting him decide.

I agree Paula, and to go along with that I think that every day cultural expectation or what is considered the norm weighs heavily on whether a person perseveres. In the part of Australia that I live in breastfeeding seems to be the 'normal' 'expected' thing to do. For most of my peers/friends etc, formula is the 'other' - what you use if you can't breastfeed. The expectation is great, unfortunately I don't think enough women take advantage of the help or services available. What is not the 'norm' in the part of the world I live in, is asking for or seeking help if you are having problems with breastfeeding. I feel most women go it alone when there are problems.

Agree very much with you Delphine. I think most women don't realize that breastfeeding an infant is basically something you have to be on call to do 24 hours, at the babies demand. It's a big deal, but it's not really that bad if your husband is on board, you resign yourself to it, and you don't have to rush off to work. It's something many women don't want to face these days, but working outside of the home and babies under a year old just really don't mix and it's a recipe for exhaustion and breastfeeding trouble to try. I do know some women who have made it work and they are extraordinary. There are matters aside from just breastfeeding that compel me to believe women need to be focused on their young children at the 0-1 (or 3, or 5 age if they can swing it) and keep their job a distant second (or third, depending on where the husband falls in). Until "feminists" give up this dogged nonsense that work is so bloody important and trumps the wellbeing of their own children, we're not going to see these rates improve. I would support policy that would enable families to live (frugally and reasonably) on one adult income, at least temporarily, rather than support direct "let's pay for childcare" policies. The general thinking on what's best for helping moms and babies is upside down right now, IMO.

About what should be the "top priority" though, it's a hard question for many reasons. One, I see that it is a "public health issue" to some extent, but so is obesity and you can see where we are with that in the U.S. People have got to want it. It's such a personal thing and there are so many small details and cultural things that affect breastfeeding. Issues of women not understanding that you have to pretty much do it all the time when the baby is first born, and really for several months after. How do you convey that without scaring the weak ones away? I think many people don't understand that a baby is a full time job, or should be. Again, modern, overstretched people trying to cram 15 lbs of "to dos" in a 10lb bag doesn't work with the primal baby creature who doesn't want to be on a schedule. It starts with labor and birth and the hospital, too, which, I think, very unfortunately, almost sets women up for failure, or at best difficulty. I had a homebirth and all the breastfeeeding stuff just kind of flowed naturally out of that. I bet the stats of extended BFing for home birth mamas or mamas who had midwives or doulas are very strong. Maybe we should do a holistic "priority" of midwives re-claiming the birth and perinatal education process and having that be more the norm than the clinical ob visit/know-nothing dr. model that is prevalent now?

I have to go back to work eleven weeks after delivery so my family can have insurance. Due to pre-eclampsia, I've been on hospitalized bed rest for 55 days now. Gosh, the insurance sure has come in handy, as has the short-term disability. I am not returning to full-time work after I fulfill my contract, but I will have to do something to pay medical bills. This is a pretty stressful situation. But I'm sure glad I can be judged by people like you and Delphine.

Also more needs to be talked about the details of the lives of the mamas and babies. An acquaintance had a babe who was actually diagnosed with "failure to thrive." This is an upper middle class person with advanced education. Baby was still sent to daycare every day. Baby still was not invited into mamas bed for cosleeping. You would think that the basics of this child being actually held and nurtured and allowed to cuddle and sleep with mom as he needed would be something these people would just go to naturally, but alas, no....I just don't get it.

I am surprised at the thing about covering up. I was not ashamed to breastfeed in public, but I did use a cover because it made me more comfortable. I nursed my (now 11-month-old) son every day at the pool this summer, using a cover. It probably made me more comfortable nursing in public, making nursing overall more possible for me. I don't think that those of us who use nursing covers are ashamed of nursing, necessarily. I have nursed all over the place (parks, restaurants, stadiums) and never gotten one dirty look or comment. Some people averted their gaze, but that didn't offend me. Many people gave supportive smiles or comments.

It is probably true that I will wean earlier than many moms who choose not to use a cover - my goal is and has been a year. Since I work full-time outside of the house, I am not interested in pumping past then, although we will go on in the mornings/at night if he is still interested.

That is a very good point. We know that many babies have artificially high weight because of those fluids, and when that water weight drops mothers are told their babies are losing too much weight.

Then there is this. I was given the "choice" to have my baby given an ounce of formula or have her kidneys checked by ultra sound because she had not urinated since birth. I think it had been less than 24 hrs. Later my midwife said she could have peed during the birth process (c-section) and no one noticed.

Let's not deride feminism in this discussion. The core of feminism is to allow all women to make the best choice for themselves. No where in feminist discussion is it said that all women must work and send their babies to day care. I am a feminist, and with my baby to be born next spring, I am choosing to stay home. However, I worked after my first was born because I was the sole earner in our house at the time (husband was a full time student). Neither choice is wrong, only a product of my circumstances at the time.

My thoughts on covering in public leading to weaning sooner are that many babies don't like to be covered after a certain age. So, if a mama has a 6 month old who will not nurse covered, and she's not comfortable ditching the cover, then she has to choose to pump or give formula when she's not at home. If she chooses formula, eventually that is going to cause her supply to drop and then it's just a short matter of time before weaning.

As a USian, I am amazed at the breastfeeding rates in Canada. You are all actually doing very well in comparison. In my state only 13% of mothers are exclusively breastfeeding at 3 months! I'm sure the biggest factor in that difference is the generous maternity leave in Canada.

"No where in feminist discussion is it said that all women must work and send their babies to day care" actually there was a big push for this in the 70s, how quickly we forget (or maybe we were not born then) and the women flooding the workplace made it harder for husbands to get jobs and drove down wages so that now both have to work in many cases unless you plan REALLY well or are old, just to run a household...so, I do blame SOME elements of feminism. Instead of placing value on mothering, many feminists did (and still do) hold raising small children as something that can be shunted off to lower skilled, lower paid workers, in effect, showing that mothering is somehow "beneath" a professional, educated, woman. This is somewhat veering off topic, but having to (or wanting to!) work a full time job months or weeks after giving birth does play a role in breastfeeding.

I agree with Olivia. I think older babies not wanting to be covered is part of the issue.

I also think that if women feel like they need to cover, they may be more likely to try to put off nursing in order to find a private space, and that can end up being cumbersome and also leading to lower milk supply/lower weight gain.

With nursing covers, like anything else, there will be a range from moms who feel they always need to be 100% covered to those who just prefer a bit of privacy during the latch on/latch off.

Wow, this really surprised me. I can't believe that at 6 months only about half of babies are EBF. I hardly know any FFers, so just from my personal experience with friends, relatives, etc. I would have thought that number much higher.

Six months is not long at all; most people should be able to manage that IMO. It goes by so fast, BFing for just 6 months is going to be one the smallest hurdles a lot of people have parenting for the rest of their lives . Mothers need more support and information!

I have to wonder if this number will change drastically as younger doctors and nurses come on the scene?

Yes, times have changes (maybe) but the policies and cultural shifts pushed on us back then linger, it takes a while to swing the pendulum and reach a middle ground. And, still, w Pelosi, in the U.S., pushing for subsidized childcare, it's not valuing mothering, it's valuing working outside the home. Im not big on government subsidies in general, but I'd rather see the gov subsidize leaves than childcare...

My only 'covering' issue was that others - including my mother - wanted me to cover up and I didn't want to. I think the current grandparent's generation that didn't BF doesn't always support BFing moms, even if that's not their intention. I was educated/stubborn enough to do things my way and not be pressured by her or anyone, but I understand why many people prefer to avoid confrontation.

Similar to my comment below about the age of doctors and nurses, I can't help but think this will change with time.

What you're describing is one tiny slice of feminism in the 1970s (and yes, I'm qualified to discuss this, since my PhD focused on class and gender identity in the 20th century U.S. and very specifically on feminist representation in the post-World War II era up to the 21st century). Calling this particularized, popularized version of feminism is the equivalent of saying all rectangles MUST be squares. And to say that "women flooding the workplace made it harder for husbands to get jobs and drove down wages" is so historically inaccurate that I don't even know where to begin. I'll just say that neoliberalism, the destruction of unions, sending jobs overseas, and the move from a Fordist to a post-Fordist economy were major contributing factors that had absolutely nothing to do with "feminism" and everything to do with an assault on the working class.

Also, I went back to work when my son was 12 weeks old. We are still nursing at 19 months and have had almost NO problems. It wasn't easy, but I made the commitment to pump and was fortunate enough to 1) have carefully educated myself about the biology, culture, and legal rights of breastfeeding and pumping; and 2) have had an excellent supply and no issues with things like mastitis, etc. He's a lovely child, developing normally, extremely happy, and very attached to both his father and me. You're metaphorically prescribing a cold medicine for the flu, and in doing so, reinforcing classist and racist stereotypes that "bad" mothers go to work. Interestingly enough, this was precisely the criticism of the type of "liberal" feminism you describe--that it excluded working-class women and women of color who disproportionately had ALWAYS worked fulltime out of necessity.

Do some reading. Start with Stephanie Koontz's The Way We Never Were. It may change your thinking about women and work. I certainly hope so.

Awesome post. I love that you wades through the statistics to get down to the real issue: less women are exclusively breastfeeding than ever before.

I think it's worth it to add how birth interventions can also lead to a bad start with breastfeeding. Pitocin, epidural pain relief, and the combination of those two can lead to a baby that is too tired to latch upon birth. Those drugs also lead to inflated birth weights, so when a mother brings baby to the pediatrician at one week, the doctor freaks the mother out by saying baby has lost "so much" weight. But really? It's water weight that the baby actually lost. Birth interventions are a huge opposing force in breastfeeding success. In addition, most doctors use the wrong standards; the WHO percentiles are meant for breastfed babies, but most doctors do not use those.

I've heard of the book and have read much on the topic and quick frankly, there's not alot anyone can tell me that would change my mind that women should be home with their babies at the VERY least from 0-1, and ideally from 0-3 or 0-5 if they can swing it. You all can figure out who to blame for the fact that so many can't (or feel that that can't do this)---somehow I could--or figure out rationalizations why it's "good" for women of small children to work. Children under 3 don't function ideally thrown into the fray of group settings for upwards of 6 hours a day and they need modeling from mom. Yes MOM.

I agree with many of the points in the OP and the thread, but for my money, the majority of the focus should be put on educating OBs, peds, midwives, and hospital staff (including the availability of IBCLCs, rather than relying on L&D nurses to give bf advice). While all the other issues are important (support, seeing other women bf), I think if we could change the medical culture, all those other issues would slowly filter away as more and more women starting breastfeeding longer and in public. (I"m also a huge advocate of bigger milk banks and more milk sharing as alternatives to formulas, but milks banks experience critical shortages, even though there are so few of them.) I've seen so many women have their bf sabotaged by their doctor or the hospital - many more than I've seen quit because their mother or husband nagged them into giving the baby a bottle. My SIL started my nephew on rice cereal at 5 months so he could "sleep better" - typical ped advice; they also had him on a schedule set him by the hospital nursery. Now, I understand not everyone can room-in every second following a birth, depending on a woman's support system and birth experience - but this kind of thing is ridiculous. Another woman I know had a baby given (delivered C section, which involves more separation from mom) a bottle and then the ped advised her to keep up the supplementation, without telling her that this would lead to a dramatic drop in supply. I think, how can a pediatrician seriously not know that dropping feedings = lower supply? The main factors of building a healthy supply are in the first few weeks of bf - be skin to skin, bf on demand and often. They (peds) are so uneducated it's terrifying, yet they have all the authority. The mom had a postpartum doula who was trying to give her (correct) information, but the mom eventually got uncomfortable and fired the doula - she wanted to do what her doctor told her. She was a nervous first time mother. Women shouldn't have to be solely in charge of their own education and advocate so hard for themselves just to have a successful bf relationship. People who claim to be in authority should be in the very least grasping some basic knowledge before they dispense advice. We were so lucky because our first pediatrician told us flat out, physicians are not taught anything about bf in medical school. We literally know nothing about it unless we educate ourselves. My second ped (and current) is an IBCLC. If the medical culture changed, then society would change. Everyone who works with pregnant women and babies should be compelled to read "Breastfeeding made simple."

The most common issue I hear from friends is a low supply. And then probably second is poor latch. A lot of these problems I think may have been exacerbated by the hospital, new mommy concerns about weight and dehydration are completely understandable but they aren't getting the support/reassurance they need my healthcare providers and that leads to the cycle of supplementing and them actually having low supply. I was lucky in a way that my hospital supported very frequent nursing (came in to remind, had LCs explain why, woke you at night) but I don't think everyone has that experience. Soreness is common and I think that prevents the frequent nursing helpful in establishing supply and without good explanations and teaching about techniques a lot of hospitals say well take a break while you're here, you have plenty of time to nurse later.

I also agree with seeing what partial means. I think it might be a bit misleading if it includes babies who get the occasional lick of food.

What a great post. This is clearly a more complicated issue than BFing vs non-BFing. I really like that you identified that what needs to be done is to target those who want to BF but have other factors influencing them.

Something that I don't see there, although you reference it a little bit, is the introduction of food at 4 months. I remember when I had my first child (we were in the US) & he hit 4 months old. It felt like EVERYONE was asking/pressuring me to feed him solids. I would respond by saying that the AAP (American Academy of Pediatrics) recommended that I exclusively BF until 6 months. Most people acted like that was crazy. Although I did introduce food at the 6 month mark, (and both of my boys happily gobbled up anything I gave them) I continued with BFing following the advice on the Kellymom website.

Finally, a shout-out to the Kellymom website. I didn't have many friends who had kids yet (although was 30ish when I had my 1st son) and wasn't receiving BFing support from my family so almost everything I learned was from Kellymom. For example, for me at least, BFing hurt. A lot. Luckily, Kellymom addressed any issue I had and it made me realize what I was going through was normal and I didn't give up. What an amazing wealth of information and support for those who want to BF but don't quite know how. :)

I am an exclusively breastfeeding SAHM of 2, a 3 month old and a 2 year old, but I still find it very helpful to understand what other mothers go through that have not been as fortunate as I with their nursing relationships. Every woman's story is different. No one can judge why a mother quit nursing. The mothers who share their stories on FFF share their very personal, often guilt ridden experiences with unsuccessful nursing and how they came to accept formula feeding. And some of them tell stories of how they never planned to nurse from birth, which is usually the hardest for me the understand, but it really is an eye-opener into what other mothers are thinking and feeling.

Speaking of the grandparents generation thoughts on BFing...My husband's grandmother, when I BFed for the first time in front of her, actually told us that BFing was a form of child abuse. In all other respects, she is a wonderful, educated lady and was a trailblazer for women's rights-running her own business when most business owners were men.

That was pretty shocking but I think more people believe this than we might realize.

I agree with everything you posted! I also started feeling the pressure to feed solids early from other moms and family who didn't realize the AAP recommended waiting until at least 6 months. My own mother tried to get to me feed solids early, "to help the baby sleep through the night" because she said that is what her mother did, and "she raised 5 children so she must be right!" I nodded my head but was shocked at what out dated, seemingly well-meaning advice she gave me.

And I also loved finding BF info on Kellymom - it is was a great, easy to use resource.

Both my children fall into the not EBF at 6 months category and it's because I did what they needed and not what the books said to do.

At 4 months, my son was trying to grab food off my plate. He nursed so long and so often that my nipples were raw and bleeding. In addition to nursing him, I fed him expressed breastmilk and he still gobbled down more than I could provide. He was up most of the night and I was exhausted. So we fed him cereal, a couple of times a day and he was HAPPY. He started SLEEPING. I could FUNCTION again. He always has been a high energy kid and at 7, he still puts away an astonishing amount of food (although you'd never know it from looking at him because he's so skinny). He walked at 9 months, climbed a tree at 18 months, mastered a two wheel bike at 4 and ran a 5K with me last year at age 6.

My daughter made it EBF to 5 1/2 months, at which point she went from sleeping all night to waking up every hour to nurse. Growth spurt, who knows, but I couldn't keep up. I have thyroid disease and keeping my supply up was a constant challenge. We introduced a meal of cereal mixed with breastmilk right before bed and bam, she was back to sleeping all night.

The point of all this is that every child is different and every circumstance is not neccesarily an obstacle to be overcome. As a white, middle class, college educated, married woman, my kids are not in the "at risk" demographic anyway, and I didn't feel like I needed to do everything possible just to keep my kids on breastmilk only. I was happy to do what i needed to do to get some sleep and preserve my sanity.

As far as low supply, I'm with Suzanne (fearless formula feeder) on questioning the percentage of women who can't produce enough milk. In the US, the number of young women suffering from hypothyroidism has increased dramatically in recent years. Many are subclinical and have to fight their doctors to get treatment. I wonder how valid that number is anymore.

What you are describing is a very small section of Feminism. It is called Liberal Feminism and is hated and derided by all serious Feminists. It blieved that the answer to ending women' oppression by men was to turn women INTO men. Sadly they are still given WAY too much "airtime" and have continued on with more nonsense like suggesting that being forced to work as a prostitute is somehow empowering to women and girls and that if we defend children from sexual abuse we are "infantilising" them. Yes, that HAS been written by these morons. But despite all efforts by the backlash, the third wavers, and the male-identified capitulators, radical feminism IS still alive. And we did wonderful things in some places, like Canada, where I am able to stay at home with my four youngest children, aged 18months to 9 years, even though my abusive and sadly, mentally ill, husband abandoned us, due to wonderful Income Support programs and lovely things like Universal Health Care. But yes, according to the Liberal Feminists I am a failure as a woman because I don't have my law degree and a full-time nanny. So please don't hate ALL the feminists, just the sell-outs who aren't smart enough to see the Patriarchy as the problem rather than women.